Delmez JA et al. (2006) Cerebrovascular disease in maintenance hemodialysis patients: results of the HEMO study. Am J Kidney Dis 47: 131–138

A secondary analysis of data from the Hemodialysis (HEMO) Study has enhanced our comprehension of the risk factors for cerebrovascular mortality in maintenance hemodialysis patients, and has strengthened the hypothesis that high-flux dialysis has a beneficial effect on the vascular system.

The randomized, controlled, multicenter trial included 1,846 hemodialysis patients. Mean follow-up was 2.84 years. At baseline, 19.5% of patients had a diagnosis of cerebrovascular disease (CBVD)—stroke, transient ischemic attack or carotid endarterectomy. Risk factors for baseline CBVD were increased age, presence of diabetes mellitus and cardiac disease (all P <0.0001). CBVD deaths occurred in 65 patients (event rate 1.2 per 100 patient-years) and were significantly associated with presence of diabetes mellitus (P = 0.032), higher hematocrit levels (P = 0.005), lower BMI (P = 0.002), and lower albumin levels (P = 0.011).

Although dialyzer flux and dose had no overall effect on CBVD death, subgroup analysis showed that patients without CBVD diagnosis at baseline were half as likely to die from CBVD if they received high-flux, as opposed to low-flux, dialysis (P = 0.016). In addition, high-flux dialysis reduced the RELATIVE RISK of CBVD death by 71% in patients who had been on dialysis for longer than 3.7 years (P = 0.012).

Similarly, previous analyses of HEMO study data revealed that high-flux dialysis reduced overall cardiac mortality by 20%. High-flux dialysis enhances MIDDLE MOLECULE removal and this might attenuate vascular disease progression. The authors suggest that studies to further assess the effect of this intervention on the vascular system of hemodialysis patients are needed.